Provider Demographics
NPI:1164189809
Name:JACQUELINE BENCE LCPC LLC
Entity Type:Organization
Organization Name:JACQUELINE BENCE LCPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:916-837-8460
Mailing Address - Street 1:96 N WEAVER STREET PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714
Mailing Address - Country:US
Mailing Address - Phone:916-837-8460
Mailing Address - Fax:
Practice Address - Street 1:11 W MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3738
Practice Address - Country:US
Practice Address - Phone:916-837-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty